Is an RNY revision the answer?
I really hope someone can help me with this. I had a roux en y gastric bypass in August 2004. By the summer of 2006, I had lost a total of 113lbs and was ecstatic. Within a couple of months, the weight started coming back on - a combination of extreme stress and a return to diet soda and sweets. I put 45 pounds back on. I've been able to take 12 of those back off and keep them off, but I can't seem to lose any more. I'm hungry nearly all the time and I know I can eat more now than I could right after the surgery. I found out last year that my pouch has stretched somewhat (the tech didn't say how much). A third problem is absorption of meds I take every day. My meds doctor has been working with me, sometimes having me take more of a certain medication more often throughout that day. Sometimes that works, sometimes it doesn't.
1. I'm still "obese".
2. My pouch has stretched.
3. Absoption problems with meds.
I really don't know what to do here. Any constructive feedback would be greatly appreciated!
1. I'm still "obese".
2. My pouch has stretched.
3. Absoption problems with meds.
I really don't know what to do here. Any constructive feedback would be greatly appreciated!
I am anxious to see what kind of replies you get as I am in the same boat as you. I had my RNY 3 years ago - lost 90 lbs. Still had 25 to go but was feeling GREAT - then the weight started coming back on - 30 lbs worth and I am having a horrible time with it!!! I also can eat more now than I could and can eat all the time because "IT SEEMS" like I am hungry. I never dump and sorta envy those that cannot eat sweets.
Darlene
Darlene
I met a couple of ladies at a surgical support group who have Lap-Band's over RNY pouches that had stretched, and they were both very slim and said they loved the Lap-Band "revision". I guess a DS revision would be the best answer in terms of weight-loss, but many insurance companies don't cover it (including mine), and revision surgery of any kind is risky. Hope you find an answer, though.
You might want to see if your PCP or your surgeon would order a endoscopy for you to see what is happening. Perhaps there is a mechanical failure of some sort that is causing your problems. Another question that comes to mind is regarding the medicine absorption - would a WLS revision make that better or worse - I would think it would make it more difficult for you to absorb your meds than you are having now as it is my understanding that after a certain period of time - the malabsorption of an RNY basically disappears as the intestine improves its capacity to absorb to compensate for the intestine lost to RNY.
If you would be self-pay iyou could likely find a surgeon to do a revision for you - I think it will be more difficult to get insurance to cover it - but of course thats assuming there is no other mechanical failure than the stretched pouch.
Some people try that 5 day pouch test and they find it helpful.
Best wishes,
Rhonda
If you would be self-pay iyou could likely find a surgeon to do a revision for you - I think it will be more difficult to get insurance to cover it - but of course thats assuming there is no other mechanical failure than the stretched pouch.
Some people try that 5 day pouch test and they find it helpful.
Best wishes,
Rhonda
mew6495
on 6/28/09 1:39 am - MI
on 6/28/09 1:39 am - MI
On June 27, 2009 at 4:12 PM Pacific Time, Jennifer J. wrote:
I really hope someone can help me with this. I had a roux en y gastric bypass in August 2004. By the summer of 2006, I had lost a total of 113lbs and was ecstatic. Within a couple of months, the weight started coming back on - a combination of extreme stress and a return to diet soda and sweets. I put 45 pounds back on. I've been able to take 12 of those back off and keep them off, but I can't seem to lose any more. I'm hungry nearly all the time and I know I can eat more now than I could right after the surgery. I found out last year that my pouch has stretched somewhat (the tech didn't say how much). A third problem is absorption of meds I take every day. My meds doctor has been working with me, sometimes having me take more of a certain medication more often throughout that day. Sometimes that works, sometimes it doesn't. 1. I'm still "obese".
2. My pouch has stretched.
3. Absoption problems with meds.
I really don't know what to do here. Any constructive feedback would be greatly appreciated!
Jennifer,
You're in a tough spot, I've been there and it's no fun, about your only choice at this point it so either diet and exercise to get the excess weight off or try for a revision. I had RNY for 28 years and was able to keep most of the excess weight off for about 15 years with diet and exercise.
But stuff happens and I had some things that made exercise pretty much impossible for a year and when that happened I lost control of my weight and I gained it all back over the course of a few years. I tried a number of times to get the diet and exercise going again, but just could never get it done. About a year ago I decided I had to really do something; I had hypertension, sleep apnea and gout. I started looking into what my options were. I found that the DS had the best excess weight loss and best results for keeping the weight off and it also offered the best quality of eating as far as being able to eat like a normal person again. And after 28 years of food sticking and dumping, I knew I didn't want more RNY so I started talking to DS surgeons who could give me a revision. I chose Dr. Rabkin and got the revision to DS last September. My only regret is that I didn't do this 10 years ago. I never would have believed my life could be like this again, I really love the DS IMO it's the best.
Anyway, you can read all the details on my profile if you want to, but for me, getting the revision to DS has been a very good thing.
As far as being able to absorb your meds, it really depends on what meds you're talking about, a lot of meds are absorbed in the stomach, so you would be much better off with the DS stomach than you are with a RNY pouch. The DS has a fully functional stomach with pyloric valve and duodenum still intact and being used. If you got a revision to DS you would get those back.
If you have any questions or if I can be of any help I would be happy to do so.
Kerry
You're in a tough spot, I've been there and it's no fun, about your only choice at this point it so either diet and exercise to get the excess weight off or try for a revision. I had RNY for 28 years and was able to keep most of the excess weight off for about 15 years with diet and exercise.
But stuff happens and I had some things that made exercise pretty much impossible for a year and when that happened I lost control of my weight and I gained it all back over the course of a few years. I tried a number of times to get the diet and exercise going again, but just could never get it done. About a year ago I decided I had to really do something; I had hypertension, sleep apnea and gout. I started looking into what my options were. I found that the DS had the best excess weight loss and best results for keeping the weight off and it also offered the best quality of eating as far as being able to eat like a normal person again. And after 28 years of food sticking and dumping, I knew I didn't want more RNY so I started talking to DS surgeons who could give me a revision. I chose Dr. Rabkin and got the revision to DS last September. My only regret is that I didn't do this 10 years ago. I never would have believed my life could be like this again, I really love the DS IMO it's the best.
Anyway, you can read all the details on my profile if you want to, but for me, getting the revision to DS has been a very good thing.
As far as being able to absorb your meds, it really depends on what meds you're talking about, a lot of meds are absorbed in the stomach, so you would be much better off with the DS stomach than you are with a RNY pouch. The DS has a fully functional stomach with pyloric valve and duodenum still intact and being used. If you got a revision to DS you would get those back.
If you have any questions or if I can be of any help I would be happy to do so.
Kerry
Sounds alot like my story, with the weight re-gain aspect. I have decided on a revision from the RNY to the DS. I have been working on getting ready to submit for mt revision to the insurance company. One last hurdle, and I should be ready.
If the insurance company will not pay (and I am not too hopeful that they will)...... I will probably stick to my plan, but have my revision done out of the country. It will cost around $15,000.00 for the revision, so that will push my timefame to around 3 years away, as well.
But, my suggestion to you, is to RESEARCH, RESEARCH, RESEARCH, and do what is best for you, and your situation. And, visit the other boards (the DS, RNY, and such, as they get more traffic)
I encourage you to post questions, that will give you feedback & life experiences from people, as well as support.
Lots to think about, but Never Give Up!!!!!
-Jamie
If the insurance company will not pay (and I am not too hopeful that they will)...... I will probably stick to my plan, but have my revision done out of the country. It will cost around $15,000.00 for the revision, so that will push my timefame to around 3 years away, as well.
But, my suggestion to you, is to RESEARCH, RESEARCH, RESEARCH, and do what is best for you, and your situation. And, visit the other boards (the DS, RNY, and such, as they get more traffic)
I encourage you to post questions, that will give you feedback & life experiences from people, as well as support.
Lots to think about, but Never Give Up!!!!!-Jamie
RNY 2/26/2002 DS 12/29/2011
HW 317 SW 263 BMI 45.1
SW 298 CW 192 BMI 32.9~60% EWL
LW 151 in 2003
TT 4/9/2003
Normal BMI 24.8 is my GOAL!!!
GBP (RNY) 2/26/02 298 lbs, TT 4/9/03 151 lbs, DS 12/29/11
HW 317 SW 263 BMI 45.1/CW 192 BMI 32.9/GW 145 ~ Normal BMI 24.8
**Revision Journey started 3/2009 Approved 12/12/11**
I am also struggling with putting weight back on. I had Open RNY 4 yrs ago, only lost 80 lbs. I too got back to drinking diet pop and sweets and bam its creeping back on. I went to surgeon in Detroit and he said I didn't need a lap band, that I already had the tool so I gave up but now I got to believe there are options so I'm thinking of going back to my original surgeon.
keep me posted
keep me posted
Thanks to everyone *****sponded to my post.
Kerry - what was your post-op diet like after the revision compared to after your initial surgery? I'm concerned because after my RNY I had to wait 3 months before going back on my meds. I don't have the support system now that I had in place at that time, so going without my medication would be extremely difficult if not impossible.
Neicey - I second what Jamie said. Never give up! It took me two different hospitals/surgeons and 2 years to finally get my surgery. Perseverance is the key...and so are second opinions!
As for my own research, so far I've learned that Medicare won't cover the StomaphyX procedure, but will cover a revision if it's medically necessary. The definition of "medically necessary" apparently varies by state as each state has it's own Medicare board that is free to set certain criteria independently of federal guidelines. For example, to qualify for a revision in Texas you must have a BMI greater than 35 and have not one, but two of the comorbidities included in a very short, narrow-scoped list. None of that applies to me. My BMI is currently 32 and fibromyalgia isn't on that list. The worst part of that is that I found a surgeon in Houston that I was very interested in contacting. He's on the board of directors for this website and has taught other surgeons how to do revisions. (I don't remember his first name off-hand, but it's Dr. Patel) Because of Texas' criteria, there's nothing he can do for me. I haven't checked with the state of TN (I live in Memphis), yet, but will very soon. My original surgeon is in LA, so going back to him isn't an option unfortunately.
I did have an upper GI either last year or late the year before due to problems I was (and still am) having with swallowing any meat that isn't ground or processed - i.e. chicken mcnuggets. They also did that horrid barium swallow test, which showed that I could swallow liquids just fine. No kidding! I wasn't there because I couldn't swallow liquids. They should have done the test with a steak! I swear I don't understand the medical profession's logic sometimes. But, I digress. The endoscopy revealed that my pouch had, indeed, stretched somewhat, but the tech who performed the test didn't give me any idea of how much. He also didn't say whether the stoma (?) outlet had stretched or not, but I guess that wasn't one of the things he was looking for.
At this point, while I'm still heavily researching the RNY to DS revision procedure, ROSE, and Lap-band after RNY, I've decided on 2 preliminary steps I need to take before making any decisions about a second surgery. First, I need to discuss with my pdoc (psychiatric med management doctor) where the meds I'm taking now absorb in the body to find out what effect various revision options would have on their absorption rates. Second, I'm going to find a surgeon locally and find out about the current state of my pouch. For the last several days I've been having terrible pain in my upper and lower abdomen from gas after I eat anything. I've had intermittent, moderate to severe gallbladder pain for the last couple of years, as well. I've no idea if the two are related or if the pain is simply a common side effect from a med i recently started. Whatever it is, I think I have a few reasons to investigate my pouch, revision aside.
In the meantime, I'm going to do my best to get back to my post op eating habits...before they started going downhill. Fewer carbs, more protein, 5-6 meals with no snacking (I know - that's the kiss of death for us), protein first, nothing to drink 30 before/after meals, and I'm going to have to cut out refined, white sugar altogether. I'm an addict and realize that I can't handle having small amounts of sweets without losing control. So, all that said, please cross your fingers, toes, knees, eyes and anything else you can cross (ADD moment - if crossing your fingers is lucky, wouldn't that make Twister the world's luckiest charm?) for my success. I'll keep you posted on that and what I find out through my research.
These are my stats:
RNY August 2004, 260lbs
July 2006, 147lbs
Jan 2007, 165lbs
April 2007, 175lbs (10lbs compliments of the fabulous food that surrounded me while living
in England for 3 months)
Jan 2009, 170lbs
July 2009, 180lbs
Goal weight: 140lbs
Kerry - what was your post-op diet like after the revision compared to after your initial surgery? I'm concerned because after my RNY I had to wait 3 months before going back on my meds. I don't have the support system now that I had in place at that time, so going without my medication would be extremely difficult if not impossible.
Neicey - I second what Jamie said. Never give up! It took me two different hospitals/surgeons and 2 years to finally get my surgery. Perseverance is the key...and so are second opinions!
As for my own research, so far I've learned that Medicare won't cover the StomaphyX procedure, but will cover a revision if it's medically necessary. The definition of "medically necessary" apparently varies by state as each state has it's own Medicare board that is free to set certain criteria independently of federal guidelines. For example, to qualify for a revision in Texas you must have a BMI greater than 35 and have not one, but two of the comorbidities included in a very short, narrow-scoped list. None of that applies to me. My BMI is currently 32 and fibromyalgia isn't on that list. The worst part of that is that I found a surgeon in Houston that I was very interested in contacting. He's on the board of directors for this website and has taught other surgeons how to do revisions. (I don't remember his first name off-hand, but it's Dr. Patel) Because of Texas' criteria, there's nothing he can do for me. I haven't checked with the state of TN (I live in Memphis), yet, but will very soon. My original surgeon is in LA, so going back to him isn't an option unfortunately.
I did have an upper GI either last year or late the year before due to problems I was (and still am) having with swallowing any meat that isn't ground or processed - i.e. chicken mcnuggets. They also did that horrid barium swallow test, which showed that I could swallow liquids just fine. No kidding! I wasn't there because I couldn't swallow liquids. They should have done the test with a steak! I swear I don't understand the medical profession's logic sometimes. But, I digress. The endoscopy revealed that my pouch had, indeed, stretched somewhat, but the tech who performed the test didn't give me any idea of how much. He also didn't say whether the stoma (?) outlet had stretched or not, but I guess that wasn't one of the things he was looking for.
At this point, while I'm still heavily researching the RNY to DS revision procedure, ROSE, and Lap-band after RNY, I've decided on 2 preliminary steps I need to take before making any decisions about a second surgery. First, I need to discuss with my pdoc (psychiatric med management doctor) where the meds I'm taking now absorb in the body to find out what effect various revision options would have on their absorption rates. Second, I'm going to find a surgeon locally and find out about the current state of my pouch. For the last several days I've been having terrible pain in my upper and lower abdomen from gas after I eat anything. I've had intermittent, moderate to severe gallbladder pain for the last couple of years, as well. I've no idea if the two are related or if the pain is simply a common side effect from a med i recently started. Whatever it is, I think I have a few reasons to investigate my pouch, revision aside.
In the meantime, I'm going to do my best to get back to my post op eating habits...before they started going downhill. Fewer carbs, more protein, 5-6 meals with no snacking (I know - that's the kiss of death for us), protein first, nothing to drink 30 before/after meals, and I'm going to have to cut out refined, white sugar altogether. I'm an addict and realize that I can't handle having small amounts of sweets without losing control. So, all that said, please cross your fingers, toes, knees, eyes and anything else you can cross (ADD moment - if crossing your fingers is lucky, wouldn't that make Twister the world's luckiest charm?) for my success. I'll keep you posted on that and what I find out through my research.
These are my stats:
RNY August 2004, 260lbs
July 2006, 147lbs
Jan 2007, 165lbs
April 2007, 175lbs (10lbs compliments of the fabulous food that surrounded me while living
in England for 3 months)
Jan 2009, 170lbs
July 2009, 180lbs
Goal weight: 140lbs
You're 40 lbs away from your goal. I don't think that warrants a revision. I would seriously just try Weigh****chers, especially since you aren't absorbing your medicine properly. What is your BMI?
Katrina
ETA: I'm sorry, I just re-read my post and realize I sound a little insensitive. I certainly understand what it feels like to gain weight. I never reached my goal though and am still gaining, so I guess I'm bitter. I wish you good luck in whatever path you choose!
Katrina
ETA: I'm sorry, I just re-read my post and realize I sound a little insensitive. I certainly understand what it feels like to gain weight. I never reached my goal though and am still gaining, so I guess I'm bitter. I wish you good luck in whatever path you choose!
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